North Carolina’s strong Obamacare enrollment at odds with state politics — Reid plans a Wednesday vote on Hobby Lobby fix

By Natalie Villacorta

07/15/14 10:01 AM EDT

With help from Paige Winfield Cunningham

NORTH CAROLINA’S DISCONNECT BETWEEN POLITICS AND ACA TURNOUT—Pro’s Jennifer Haberkorn visited the Tar Heel state to investigate the disconnect between its strong Obamacare enrollment showing and its political environment. Despite the state’s 357,000 exchange sign-ups, the health law remains a major liability for Sen. Kay Hagan, who faces one of the toughest reelection races for any Senate Democrat this year against North Carolina House Speaker Thom Tillis. Many North Carolinians said they only signed up because of the individual mandate, the Koch brothers are pouring millions into ads that attack Kagan for her Obamacare vote, and it’s unclear if voters like their coverage enough to shift Democratic.

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-- “The North Carolina dynamic reflects a national problem for the Obama administration in this midterm election: Despite the solid numbers — 8 million enrolled in Affordable Care Act plans, and 6.7 million signed up for Medicaid — they just can’t move the dial on political support for Obamacare,” Haberkorn writes. http://politico.pro/1zDcaka

Welcome to PULSE, where I am aching from participating in D.C.’s newest cardio craze, 305 Fitness, which markets itself as feeling like “a night out partying disguised as a workout.” I’m really glad that Mayor Vincent Gray vetoed the “yoga tax” last week, because I couldn’t have handled a tax on top of a $26 hour-long class. (Full disclosure: Classes were free this week and the founder went to my alma mater).

--THIS MORNING a decision on Halbig v. Burwell may drop. If it does, Pro’s got you covered.

“N-now th-that that don’t kill me, can only make PULSE stronger.”

HOBBY LOBBY VOTE WEDNESDAY — Senate Majority Leader Harry Reid plans to hold a vote tomorrow afternoon on Democrats’ legislative response to the SCOTUS Hobby Lobby ruling that exempted some corporations from the Obamacare contraception mandate. It’ll just be a procedural vote, and since Democrats need 60 votes to move forward on it, it’s expected to fail. But it’ll still achieve Democrats’ objective of getting their message out. The bill would essentially reverse the justices' decision, prohibiting any employer health plan from not covering any item required by federal law.

KAISER SURVEY: ENROLLMENT ASSISTERS PLAYED BIG ROLE IN STATE-RUN EXCHANGES—In the first nationwide assessment of Obamacare enrollment assisters, a Kaiser Family Foundation survey released today found that 28,000 assisters helped about 10.6 million Americans nationwide apply for health coverage during the first open enrollment period. The most interesting part? Nearly half of those assisters worked in those 16 states and the District of Columbia — where just about a third of uninsured Americans live. That meant they ended up helping twice as many people as programs in states that relied on HealthCare.gov. Assisters thought they were swamped the first time around, but demand is likely going to be even greater this fall, Kaiser predicts. Some of the 8 million people who signed up initially may need help re-applying, plus 5 million more people, according to the Congressional Budget Office, will enroll for 2015, and they’re bound to have questions. The Pro story: http://politico.pro/1jtLTzS The survey: http://bit.ly/1rcsKVR

BASELINE ESTIMATE FOR THE STATE OF HEALTH CARE—Douglas Holtz-Eakin and other economists at the bipartisan Center for Health and Economy released an updated report yesterday on the ACA’s costs and effects. This year, the individual market includes about 35 million people, with 6 million lives covered under subsidized plans. Expect the individual market to grow to 50 million people by 2016, with 25 million on subsidized plans, H&E says. A growing risk pool means that premiums will fluctuate for a few years, but after 2017, the Center predicts, premiums will grow by 2 to 6 percent. Over the next decade, H&E predicts that coverage provisions of the ACA and Medicaid will cost the federal government a whopping $3.33 trillion. http://bit.ly/1wmjE6B

ACA ISN’T DRIVING UP PATIENT VISITS—The first report from a new collaboration between the Robert Wood Johnson Foundation and athenahealth that’s looking at the impact of the ACA says health care providers have yet to see an increase in new patient volume. In fact, the percentage of total visits with new patients decreased slightly compared to the same period last year. And the new patients aren’t any sicker — established patients had a higher rate of chronic disease than new patients, the report found. But Medicaid beneficiary visits are increasing. Primary care docs said 15.6 percent of their visits were with working age adults on Medicaid compared to 12.3 percent last December. States not expanding Medicaid aren’t seeing the same increase. The ACAView project will monitor the ACA’s impact on providers, patients and providers though 2016. The report: http://bit.ly/1wn0ZHP

-- BUT: Aaron Carroll writes on the Upshot that a growing body of evidence suggests that improving access to health care — the goal of the ACA — sometimes increases use of pricey services. http://nyti.ms/1qZVBuS

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WHITE HOUSE: IRS BUDGET BAD FOR OBAMACARE—Yesterday, the White House budget office recommended that President Obama veto legislation that it says would impede ACA implementation. H.R. 5016 would slash the IRS’s budget by $341 million below current levels in the 2015 fiscal year. The House is expected to vote this week on the budget, which will have to be reconciled with a more agency-friendly Senate version.

MEDICINE VS. THE LAW — State abortion restrictions are forcing doctors to choose between their medical training and obeying the law, according to report released yesterday by the National Partnership for Women & Families. Thirty-three states have laws that go against the evidence and prioritize political beliefs over patient safety, the report says, requiring unnecessary ultrasounds, biased counseling and mandatory delays, and restricting medication abortion. Sixteen states have all four types of laws.

--A paper from the Charlotte Lozier Institute, the research arm of the anti-abortion rights group Susan B. Anthony List, describes how the bill would upend restrictions on abortion. According to Chuck Donovan, president of the Charlotte Lozier Institute, the “ sweeping legislation would jeopardize or outright overturn hundreds of federal and state laws that promote unborn life and protect women’s health.” http://bit.ly/1qBem5v

OUCH, PUBLIC HEALTH GOT BUDGET CUTS—Public health is still hurting from federal budget cuts, according to a report released today by a coalition of 90 public health groups. The coalition says the cuts are damaging to Americans’ health — hampering the country’s ability to prevent and control outbreaks of measles and MERS, recruit physicians to rural areas and curb the opioid abuse epidemic. If lawmakers don’t act, the full impact of sequestration will return in 2016, the groups say. At noon today, they’re holding a briefing to discuss the report in Dirksen 562. http://www.cutshurt.org/

CERTIFICATE OF (UN)NEED—Don’t let their name fool you. Certificate-of-need laws don’t help the needy, according to a new paper published today by the Mercatus Center at George Mason University. Thirty-six states and D.C. have CON laws, which are intended to reduce health care costs by limiting unnecessary services but which might actually be increasing the price of medical care by hampering new competition from entering the health care market, the authors write. And there’s no evidence that CON laws improve low-income individuals’ access to health care. The paper: http://bit.ly/1js52Ca

HOW ARE OUT-OF-POCKET COSTS CHANGING IN 2015?—It depends on the metallic tier, according to HealthPocket, which examined rate filings in nine states. Silver plans look like the best bet: Deductibles are decreasing, and so are co-payments and maximum out-of-pocket costs. Gold plans are also looking good, but those maximum OOP costs are going up. Some bad news for bronze plans: Higher specialist co-pays are going up, though deductibles are going down. And don’t even ask about platinum plans. For the curious: http://bit.ly/1yilGaL

WHAT WE’RE READING

A second look into last month’s anthrax scare at the CDC has revealed additional safety lapses, according to memo prepared by the House Committee on Energy and Commerce’s oversight subcommitee, the Washington Post reports: http://wapo.st/1kr6vnF

Changing the color and shape of drugs when manufacturing generics may prompt patients to stop taking them, the Los Angeles Times reports: http://lat.ms/U61B8f

Rep. Phil Gingrey, a medical doctor, is making claims about the child migrants from Central America that lack evidence, Mother Jones reports. For one, that the children lack vaccinations, which is notable given that the congressman has denounced some mandatory vaccinations in the past: http://bit.ly/1sUEZ6Y

LIVE TODAY – ALL POLICY IS LOCAL: Health Care – the third coverage area in POLITICO’s ongoing series reporting on the intersection of policy and the 2014 midterms, and the impact on industry and communities across the country. Don’t miss the must-read piece by Jennifer Haberkorn reporting on the ground from North Carolina – a state with one of the biggest Affordable Care Act signup successes, but surprisingly, a political peril for candidates. Get the full story here: http://politi.co/1kWpHtm.

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